Definition

Developmental Coordination Disorder (DCD) is a condition that affects physical coordination. This disorder makes it difficult for a child to perform activities as well as their peers, and they may appear clumsier in their movements. DCD is observed 3-4 times more frequently in boys than in girls and can present challenges that persist into adulthood.

Causes

Coordinated movements, such as playing sports, involve a complex process that requires various brain regions and nerves to work together. If the brain regions associated with coordinated movement experience issues, a person may struggle with coordination. The exact cause of DCD is still unknown, and it usually occurs without any other underlying conditions. However, other conditions such as high lead levels, anemia, or iron deficiency must be ruled out to diagnose this disorder.

Risk Factor

Although the exact cause of DCD remains unknown, several risk factors have been identified. These factors can stem from environmental conditions, circumstances during pregnancy, and genetics. During pregnancy, exposure to alcohol and illegal drugs like cocaine and methamphetamine increases the risk of a child developing DCD later in life. Alcohol has a direct effect on the fetal nervous system, while cocaine and other stimulants are thought to cause blood vessel constriction and cell death in various areas of the fetus's body, including the brain.

Other risk factors include premature birth and genetics. The earlier a baby is born prematurely, the higher the risk of developing nervous system disorders, which can later lead to difficulties in sustaining attention for extended periods, self-control, and coordinated movements. Additionally, DCD has a complex genetic component that may also involve environmental factors.

Children with DCD may not have any of the mentioned risk factors, but the condition still requires extra attention to help the child perform daily activities.

Symptoms

Symptoms of DCD can be observed before the age of one year. As children grow, they are expected to crawl, walk, pick up food with their hands and bring it to their mouths, and dress themselves. In children with DCD, these abilities may develop later than usual. The condition can also become apparent in school-aged children who struggle with drawing, coloring, cutting, writing, and sports compared to their peers. Additional symptoms include unsteady walking, difficulty descending stairs, frequently dropping objects, tripping, difficulty tying shoelaces, dressing, and other self-care activities.

Although these signs and symptoms can appear before the age of one, children with developmental delays do not necessarily have DCD. Developmental speeds can vary widely in early life. Therefore, a definitive diagnosis is usually not made until after the age of five or when the child starts school.

Diagnosis

Diagnosing DCD can be challenging because its symptoms can be mistaken for other disorders. Therefore, a comprehensive history will be taken by the doctor. DCD is specifically characterized by delayed motor development that interferes with daily activities. These symptoms start early in life and cannot be explained by intellectual disabilities, visual impairments, or brain issues.

Before the examination, a child might express dislike, frustration, anger, or sadness related to their symptoms. For example, a child might say, "I don't like drawing" because they find it difficult. Children who express similar complaints across various activities should be evaluated further, as these complaints could indicate DCD.

The examination will be based on suspicions of DCD. The child may be asked to perform various activities, such as shaking hands firmly, throwing and kicking a ball, cutting objects, drawing or coloring, tying shoelaces, or getting dressed. Special tests might also be conducted to assess different components of the child’s coordination, like maintaining a position against gravity, finger-to-nose pointing, moving limbs against resistance, fine motor skills (detailed movements such as writing, drawing, and eating), and gross motor skills (standing, walking, and running). Spatial ability tests (recognizing spaces) may also be performed to identify other possible conditions.

Management

The goal of treating DCD is to identify specific problematic areas for the child and develop therapies that can improve functional adaptation and train the skills that need development. Based on this goal, treatment may involve long-term educational programs, physical therapy, occupational therapy, and social skills training.

Adapting daily functions can be done by breaking down complex movements into smaller parts and practicing them repeatedly. Additionally, functional adjustments can be made using tools, like pencil grips to make writing easier. Adaptations can also involve using alternative methods to complete tasks, such as using a computer to type instead of handwriting assignments.

Physical therapy may include exercises, especially individual sports like swimming or cycling. In DCD, regular exercise is crucial to train the brain-body coordination and prevent overweight. Meanwhile, occupational therapy is needed to help children develop everyday self-care activities. Therapists may also collaborate with schools on how tasks are assigned to children.

Complications

Children with DCD often have other associated difficulties, typically related to attention and concentration, such as Attention Deficit Hyperactivity Disorder (ADHD). Other conditions that may co-occur include autism spectrum disorders, like Asperger syndrome.

Many children with motor disorders also experience language problems, such as stuttering, difficulty recognizing phonology (word sounds), receptive language disorders (difficulty understanding what is communicated to them), or expressive language disorders (difficulty expressing thoughts through speech, writing, sign language, etc.). Additionally, these children are more dependent than their peers and have a higher tendency toward obesity. DCD usually persists into adulthood, so appropriate training is necessary.

Prevention

Preventing DCD is very challenging. However, parents preparing for pregnancy or who are currently pregnant can reduce the risk of their child developing this disorder by avoiding alcohol and illegal drugs. It's important to note that some individuals can develop DCD even in the absence of known risk factors.

When to See a Doctor?

If you are concerned about your child's development, you should visit a general practitioner or pediatrician for an evaluation. It's also recommended to have your child's development checked at least every six months until they reach the age of five to ensure they are on track. The sooner DCD is identified, the quicker interventions can be implemented, allowing the child to better adapt to the condition.